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General NPI Number Information
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NPI Number | 1578934790
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Entity Type | Individual
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Provider Name | ZILLA F HENRICKSEN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 5194 HIGHWAY 100 STE 106
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City | LYLES
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State | TN
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Zip | 37098-2822
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Country | US
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Telephone | 931-670-1102
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Fax | 931-670-1065
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Provider Business Mailing Address
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Address Line | 127 CRESTVIEW PARK DR STE 209
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City | DICKSON
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State | TN
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Zip | 37055-2856
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Country | US
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Telephone | 615-446-5121
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Fax | 615-446-1357
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP129005
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN19374
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License Number State | TN
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